Revision Surgery for Delayed Gastric Conduit Emptying after Subtotal Esophagectomy with Retrosternal Reconstruction

A 74-year-old woman underwent subtotal esophagectomy with gastric tube reconstruction via a retrosternal route for thoracic esophageal cancer. She experienced repeated vomiting at 3 months after surgery. Delayed gastric conduit emptying was diagnosed because the gastric tube was redundant and dilated into the right thoracic cavity. Revision surgery was performed two weeks after unsuccessful conservative treatment. Operative findings under laparotomy revealed that the antral zone of the gastric tube was firmly attached to the dorsal side of the xiphoid. We added a right thoracotomy with a sixth intercostal incision to secure a good surgical field. The gastric tube had dilated and bent above the right diaphragm, and the outflow tract of the gastric tube was obstructed by the left liver lobe and xiphoid. We incised the diaphragm and pulled the gastric tube toward the abdominal cavity. The diaphragm was closed and the gastric tube was fixed to the diaphragm. The postoperative course was uneventful and no delayed gastric conduit emptying has been seen for one year postoperatively.